NEW CLIENT INQUIRY

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First Name *

Last Name *

Email *

Phone *

Preferred Method of Contact *

Phone Call Text Message Email

Best Times to Reach You *

Date of Birth *

Please provide a brief description of your condition *

On a scale of 1–10, with 10 being severe, how would you rate the pain you're feeling? *

How long have you been dealing with this condition? *

Have you seen a physician for this condition? *

Have you seen other healthcare providers for this condition?

Have you had any imaging of your condition? *

What services are you interested in?

Integrative Performance & Aging Therapy Cold Laser Therapy Pulsed Electromagnetic Field Therapy Frequency Specific Microcurrent Neux Pro Muscular Reeducation Virtual Consultations Injury Recovery Personal Training

Acknowledgment of Payment Policy *

I understand that the Human Performance Center is a self-pay practice. Insurance is not accepted. All payments are due at the time of service. We accept cash, credit cards, checks, and payment plans are available at the discretion of the practice.

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Our Studio

825 Early St · Santa Fe, NM

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Human Performance Center

Fred & Kele McDaniel

825 Early St. Ste. G
Santa Fe, NM 87505
(505) 992-1088

Santa Fe, NM